When large VSDs are uncorrected, the resulting pulmonary hypertension can reverse the shunting of blood across the defect. In other words, the previously "left to right" shunt becomes "right to left." This type of complication is called Eisenmenger's syndrome.
Here, the deoxygenated blood crosses to the left and mixes with the oxygenated blood coming from the lungs. This mixed blood, with a decreased level of oxygen, is then sent to the rest of the body.
What direction is the shunt in an Eisenmenger effect:
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